RU2547784C1 - Method for fixing vascularised periosteal-cortical graft - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: one of ends of a periosteal-cortical graft is separated from the periosteum by stripping and turning it off together with feed vessels. A niche is formed in an end face portion of a projecting bone fragment at the level of the bed depth formed in an opposite bone fragment, and at the height enabling bringing one of the ends of the bone graft behind. The periosteum-free end of the bone graft is brought into the niche in the projecting bone fragment, pressed to the bed surface in the opposite bone fragment and fixed with elastic tension. The stripped periosteum is laid on the end face of the projecting end fragment and fixed.

EFFECT: method enables improving functional results, reducing the length of treatment.

Description

The invention relates to the field of reconstructive traumatology, i.e. to a method for fixing a vascularized periosteal-cortical graft. It can be used in specialized departments of reconstructive surgery, microsurgery, traumatology and orthopedics.

In reconstructive traumatology, a method is known for fixing a cortical graft in the recipient zone, when a bed in the recipient zone is formed with a greater curvature than the free surface of the cortical plate of the autograft, after which the central part of the cortical plate is bent with elastic stress until the cortical plate of the autograft completely contacts the surface of the bed, then part is fixed to one of the bone fragments of the recipient zone; to the same bone fragment, one is fixed The end of the cortical plate, or the bed in the recipient area, is formed of less curvature than the free surface of the cortical plate of the autograft, after which the cortical plate is bent with elastic tension until the cortical plate of the autograft is completely in contact with the bed surface and the ends of the cortical plate are fixed (Milanov I.O., Zelyanin A.S., Filippov V.V., Nazoev K.V., Leonov S.A., Gudkov D.S., Teplyuk P.A. RF Patent No. 2440054, IPC A61B 17/56. The method of fixation of a cortical transplant in the recipient area // Bull. No. 2 dated January 20, 2012 by application No. 201021509/14 (030541) dated May 27, 2010).

However, the known method is not technically applicable in conditions of reposition of bone fragments with the location of their surfaces at different levels.

The objective of the invention is a method of fixing a vascularized periosteal-cortical graft, which allows to increase the effectiveness of surgical treatment, improve functional results, reduce surgical risk, and also reduce treatment time.

The problem in the method of fixation of a vascularized periosteal-cortical graft, including the formation of a bed in the cortical plate of one of the bone fragments according to the size of the bone graft and its fixation with elastic stress, is achieved by the fact that in conditions of reposition of bone fragments with the location of their surfaces at different levels, one from the ends of the periosteal-cortical graft, they are freed from the periosteum by peeling and turning away together with the supply vessels, after which the front part of the protruding bone fragment form a niche at the level of the depth of the bed formed in the opposite bone fragment and with a height that allows one of the ends of the bone graft to be tightly inserted, the end of the bone graft freed from the periosteum is led into a niche in the protruding bone fragment, pressed to the surface of the bed in the opposite the bone fragment and is fixed with elastic tension, the exfoliated periosteum is placed on the end face of the protruding bone fragment and is fixed.

The proposed method and features that distinguish it from those known in the medical and patent literature are not found, which allows us to conclude that its criterion of "novelty" is met.

The essence of the invention lies in the fact that under conditions of reposition of bone fragments with the location of their surfaces at different levels, one of the ends of the periosteal-cortical graft is freed from the periosteum by peeling and unscrewing along with the supply vessels, after which they form in the end part of the protruding bone fragment a niche at the depth level of the bed, formed in the opposite bone fragment, and height, allowing you to tightly get one of the ends of the bone graft, freed about t of the periosteum, the end of the bone graft is led into a niche in the protruding bone fragment, pressed against the surface of the bed in the opposite bone fragment and fixed with elastic tension, the exfoliated periosteum is placed on the end face of the protruding bone fragment and fixed.

It is the release from the periosteum of one of the ends of the vascularized periosteal-cortical graft by exfoliating and turning it away with the supply vessels, the formation of a niche in the end part of the protruding bone fragment at the depth level of the bed, formed in the opposite bone fragment, and with a height that allows one to tightly insert one of the ends bone graft, allows in conditions of reposition of bone fragments with the location of their surfaces at different levels is safe for blood supply to wax of the transplanted graft, prepare one of the ends of the graft for fixation and form a niche commensurate with the niche in one of the bone fragments at the required level, ensuring the accuracy of the correct position of the graft without the risk of further displacement. In turn, inserting one of the ends of the bone graft, freed from the periosteum, into the niche in the protruding bone fragment allows the bone graft to be positioned correctly and proceed to the next stage - pressing it against the bone surface in the opposite bone fragment and fixing it with elastic tension, providing dynamic stability, optimal contact of the graft with bone fragments, the full realization of the properties of the vascularized graft. In turn, the laying and fixation of the detached periosteum on the end face of the protruding bone fragment stabilizes the position of the supply vessels and periosteum, while at the same time providing the most complete manifestation of the properties of the vascularized graft in the recipient zone.

The combination of these factors not only reduces the surgical risk, but also increases the effectiveness of surgical treatment, and also reduces the treatment time due to the full realization of the potential of a well-supplied, osteogenetically active periosteal-cortical graft.

Thus, the totality of all the distinguishing features allows you to achieve your goal and get a positive result.

The method is as follows: Under conditions of reposition of bone fragments with the location of their surfaces at different levels, a vascularized bone graft is taken. In a bone fragment with a deeper surface, a bed is formed in the cortical plate according to the size of the middle part and one of the ends of the bone graft. The other end of the periosteal-cortical graft is freed from the periosteum by peeling and turning away together with the supply vessels. After that, a niche is formed in the end part of the protruding bone fragment at the depth level of the bed formed in the opposite bone fragment and with a height that allows one of the ends of the bone graft to be tightly inserted. The end of the bone graft freed from the periosteum is inserted into a niche in the protruding bone fragment, pressed against the surface of the bed in the opposite bone fragment, and fixed with elastic tension. The exfoliated periosteum is placed on the end face of the protruding bone fragment and fixed.

Clinical example:

1. Patient F., 48 years old, and / b No. 23893/2013.

Clinical diagnosis: Atrophic false joint of the right femur.

From the anamnesis: Fracture of the femur as a component of multiple combined injuries in a traffic accident in 2002. For a fracture, and then a false joint, it was repeatedly operated using submersible and external metal fixators. Entered with signs of a formed false joint.

The patient underwent reconstruction of the femur with a fence and the use of a vascularized periosteal-cortical autograft, i.e. according to our proposed method, during surgery under conditions of reposition of bone fragments with the location of their surfaces at different levels, a vascularized bone graft was taken. In the distal bone fragment of the femur with a deeper surface, a bed is formed in the cortical plate according to the size of the middle part and one of the ends of the bone graft. The other end of the periosteal-cortical graft is freed from the periosteum by peeling and turning away along with the supply vessels. After that, a niche is formed in the end part of the protruding proximal bone fragment at the depth level of the bed formed in the opposite bone fragment and with a height that allows one to tightly insert one of the ends of the bone graft. The end of the bone graft freed from the periosteum is inserted into a niche in the protruding bone fragment, pressed against the surface of the bed in the opposite bone fragment, and is fixed with elastic tension. The exfoliated periosteum is laid on the end face of the protruding bone fragment and is fixed.

The proposed method is implemented in the RSCH them. Acad. B.V. Petrovsky RAMS, GBOU First MGMU them. THEM. Sechenov and will be widely used in clinical practice.

Using the proposed method for fixing a vascularized periosteal-cortical graft allows:

1. Improve the effectiveness of surgical treatment

2. Reduce surgical risk

3. Reduce treatment time.

Claims (1)

A method of fixing a vascularized periosteal-cortical graft, including the formation of a bed in the cortical plate of one of the bone fragments according to the size of the bone graft and its fixation with elastic stress, characterized in that under conditions of reposition of bone fragments with the location of their surfaces at a different level, one of the ends is periosteal -cortical transplant is freed from the periosteum by peeling and turning away along with the supply vessels, after which I protrude in the end part its bone fragment form a niche at the depth level of the bed, formed in the opposite bone fragment, and a height that allows you to tightly get one of the ends of the bone graft, the end of the bone graft released from the periosteum is inserted into a niche in the protruding bone fragment, pressed to the surface of the bed in the opposite bone fragment and fixed with elastic tension, the delaminated periosteum is laid on the end face of the protruding bone fragment and fixed.